DoD widens addiction treatment options

Oct. 31, 2013 - 04:15PM
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A new treatment option soon will be available for service members and Tricare beneficiaries addicted to powerful painkillers.

In a rule that goes into effect Nov. 21, the Defense Department lifted a restriction that prohibited Tricare from covering certain drug therapies used in substance abuse treatment.

The change involves medications such as buprenorphine and methadone, considered potentially addictive for prolonged detoxification or long-term maintenance therapy.

The drugs work by easing cravings for painkillers and blocking their effects, as well as suppressing withdrawal symptoms such as nausea, tremors and depression.

Previous rules allowed Tricare to cover the medications only for short-term, intense detoxification or pain management. But the medical community has found them to be effective as part of an overall treatment plan to wean patients from opiate painkillers such as OxyContin, Percocet and Vicodin.

“Medication-assisted treatment, to include drug maintenance involving substitution of a therapeutic drug with addiction potential, for a drug of addiction, is now generally accepted ... and thus appropriate for inclusion as a component in the Tricare-authorized substance use disorder treatment,” according to the rule, published Oct. 22 in the Federal Register.

The proposal has been in the works for at least three years but gained steam after an Institute of Medicine panel in September 2012 urged the Pentagon to change the restrictions. In a report prepared for DoD, top IOM researchers recommended updating Tricasre’s substance abuse treatment policies “to reflect the practice of contemporary health plans and be consistent with the range of treatments available.”

But medications such as buprenorphine, also known as Suboxone or Subutex, and methadone aren’t without their own problems.

Side effects can include headaches, nausea, mood swings and sleeping problems. And they can depress respiratory rates — a danger especially when taken with other medications with the same potential consequences.

Methadone contributed to the deaths of at least 60 of 430 service members from 2001 to 2011 who also were taking the antipsychotic quetiapine, also sold as Seroquel.

Pain medication abuse remains a concern in the military, where prescriptions for such drugs have skyrocketed in the past decade.

According to data compiled by the Armed Forces Health Surveillance Center, the incident rate of opioid abuse diagnoses among active-duty troops soared from 15 per 100,000 person-years in 2000 to 80 per 100,000 person-years in 2011.

A person-year is a statistical measure of the number of years that members of a population have been affected by a particular condition multiplied by the number of members in that population. It is often used in military epidemiological studies to account for the changing numbers of personnel serving in the military each year.

A 2011 survey of active-duty members indicated that about 5 percent of troops taking any prescription in the year preceding the survey said they had abused prescription painkillers.

A similar survey conducted in 2008 showed that prescription drug misuse among service members nearly tripled from 2005 to 2008, from 4 percent to 11 percent.

Researchers cautioned that the increase may have been due in part to changes in the survey’s wording. In addition, the category of “prescription drugs” includes steroids and stimulants, more commonly misused by troops than painkillers, according to the 2011 survey.